I was 3+4 after biopsy and 4+3 after surgery, but I had none of the adverse findings that you have. I have BRCA2 However, which causes your DNA to be unable to fix DNA errors that leads to prostate cancer. I’m still alive after 15 years and four reoccurrences

You know already that your cancer is very aggressive and chance of reoccurrence is quite high. Getting a decipher test can tell whether or not your chance of reoccurrence is high medium or low. I know people with Gleason 9 that have lived 20 or 30 years after surgery or radiation. The proper treatment can really extend your life.

You don’t mention your age, but if you are under 70 surgery may make a lot more sense. Yes, it can cause problems. If your doctor can spare your nerves during surgery. It can help a lot to maintain an erection. An MRI can tell the doctor whether or not it’s likely that the nerves can be spared. Long-term results are almost the same with radiation or surgery but if you are younger and have surgery, you can have a radiation later. With a reason nine that is something you should look forward to.

Do you have small or large cribriform in the biopsy report? The answer to that is critical. If your cancer has spread outside the prostate, then radiation sooner is recommended.

There is evidence to support the use of adjuvant radiotherapy in high-risk patients. EORTC 22911, SWOG 8794, and ARO 9602 all showed a biochemical progression-free survival benefit for adjuvant radiotherapy, compared to observation, for patients with adverse pathologic features.2-4 However, the use of adjuvant radiotherapy in clinical practice remains low (estimated < 10% of patients who meet the criteria).

Dr. Efstathiou concluded as follows:
* Early salvage radiotherapy is favored over adjuvant radiotherapy in most patients
* Consider adjuvant radiotherapy in otherwise fit, motivated, very high-risk patients with ≥2 of the following risk factors:
* pT3b-4
* Gleason score 8-10
* pN+ Lymph node Metz
* Decipher score >0.6
* In high-risk patients, use lower thresholds to initiate ‘ultra-early salvage or adjuvant-plus’ radiotherapy
* If giving adjuvant radiotherapy, it implies high-risk disease. Thus, Dr. Efstathiou would recommend treating the prostate bed and pelvic lymph nodes, in addition to short-term versus long-term ADT, depending on risk factors
* May consider genomic classifiers or artificial intelligence tools to help with informed decision-making
* The goal is to avoid (or delay) radiotherapy in those who we can, without missing a window to cure patients who are guaranteed to recur

Here is the link to the article originally posted here by @surftohealth88.
https://www.urotoday.com/conference-highlights/apccc-2024/151546-apccc-2024-debate-how-to-best-manage-a-fit-patient-with-high-risk-localised-and-locally-advanced-prostate-cancer-how-to-select-patients-for-adjuvant-therapy-after-radical-prostatectomy-and-how-to-treat-them.html

I am 2 weeks post op, I had a consultation with an RO, he told me that it isn’t common to start treatment early anymore but would prefer monitoring to watch the PSA.